Provider Demographics
NPI:1558639245
Name:GILLEN, SARAH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:GILLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6357
Mailing Address - Country:US
Mailing Address - Phone:817-488-2707
Mailing Address - Fax:817-488-2631
Practice Address - Street 1:1100 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6357
Practice Address - Country:US
Practice Address - Phone:817-488-2707
Practice Address - Fax:817-488-2631
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist